RIO DE JANEIRO—Until recently, it seemed as if the worst of the coronavirus pandemic was finally over in Manaus, a city of more than 2 million people in the middle of the Brazilian Amazon. As the number of COVID-19 cases slowed in June, authorities dismantled field hospitals. Bars and river beaches reopened soon after, drawing crowds of people out of isolation. In September, children went back to school, packing into cramped classrooms.
Just a few months earlier, the city was the epicenter of Brazil’s coronavirus outbreak. At the peak of the crisis, patients with COVID-19 in Manaus died at four times the national mortality rate. Public hospitals overflowed, and city workers dug mass graves. By September, the coronavirus had infected 66 percent of people, leading researchers to question whether Manaus was the first city in the world to reach herd immunity.
Those hopes were dashed in recent weeks as COVID-19 cases in the city spiked again among people who hadn’t been infected, triggering another round of restrictions as the mayor shut down the bars and beaches. João Hugo, a doctor who oversees a Manaus hospital, saw the number of patients climbing in early October. The critical care unit began to fill up as more people arrived with symptoms of COVID-19.
“There was an easing of restrictions. People saw the number of cases wasn’t rising, and they felt safe again,” Hugo said in mid-October. “The wealthier class came out of quarantine, and we started seeing a spike in new cases. The virus is now spreading among those who were isolating.”
Brazil has battled one of the world’s worst coronavirus outbreaks, with 5.4 million confirmed cases and 158,000 people dead. Despite the government’s chaotic handling of the pandemic, the virus appeared to be slowing down. This week, the daily average of COVID-19 deaths fell to its lowest since early May. But spikes in new infections, like the one in the state of Amazonas, cast doubt on Brazil’s progress. Its public health system is especially vulnerable due to the closure of field hospitals set up in April and May to cope with the initial surge.
The emergency facilities helped alleviate the pressure on public hospitals at the peak of the crisis. Now health professionals worry that in Brazil’s poorer northern states, hospitals with fewer resources may come under strain again.
In Amazonas, there are now 480 hospital beds available for COVID-19 patients, down from more than 1,200 at the end of June, according to the state’s health department. Around 68 percent of the state’s 270 critical care beds—all of them located in Manaus—are already occupied. “With the stabilization in the number of cases and hospitalizations, these [hospital] beds were redistributed in the public health system to serve patients with other illnesses,” a spokesperson for the department wrote in an email.
Doctors in the northern state of Amapá have seen a similar uptick in cases in recent weeks. Aljerry Rêgo, who runs the only dedicated COVID-19 facility left in Macapá, the state capital, said the clinic emptied out in early August. But in mid-October, the 30 available critical care beds began rapidly filling up again. “This is already a worrying trend,” he said. “The last time I had so many patients in ICU was during the peak in May and June.”
Concerns are mounting about how remote areas that often lack health facilities will cope with the surge. In Amazonas, an increase in travel from Manaus to rural areas has in part driven the increase in new cases. “People started returning to the countryside to visit their family members, bringing the virus with them,” Hugo said. “So there was a migration, from the capital to the countryside, which is putting more demand on the public health system there.” In remote parts of the state, patients must travel for days by boat to reach a hospital.
Deaths from COVID-19 are also on the rise nationwide in Brazil’s indigenous communities, rising by one-third over the last month, according to official figures from the country’s indigenous health ministry. Since the start of the pandemic, indigenous groups have recorded more than 38,000 cases and nearly 900 deaths, but a lack of diagnostic testing means the toll is likely much higher.
Advocates say indigenous people are particularly vulnerable, with little assistance from the government. Vanderlecia Ortega dos Santos, a nurse from the Witoto tribe, has cared for around 500 families living in the Parque das Tribos, an indigenous region on the outskirts of Manaus. Most community residents have already experienced symptoms of COVID-19, and some still have lingering side effects. “I’m still really afraid,” dos Santos said. “Here in the Parque das Tribos, we continue to provide preventative guidance to our people. … We don’t know if they can be reinfected.”
The surge in COVID-19 cases coincides with forest fires in the Amazon and the Pantanal wetlands. In these regions, health systems have come under strain as more patients arrive at hospitals sickened by ash and smoke, which compounds the effects of COVID-19. “Our indigenous people who live in areas where the deforestation is really intense, the fires are advancing into their territories, and this is really affecting their health,” dos Santos said. “Respiratory problems increase without a doubt. And for people who are sick with COVID, who have had their lungs really compromised, the smoke only aggravates this.”
Rio de Janeiro’s health system is also coming under renewed pressure, according to health workers. “We’re at a critical level,” said Diana Curado, a doctor at a public hospital in the city’s western outskirts, who noted that she had seen some suspected reinfections. “At this moment, we’re at the limit. … We are running the risk of going back to having people on the waiting list, people dying waiting for an ICU bed.”
While European countries are imposing fresh restrictions, Brazil is unlikely to follow suit. Local governments struggled to impose lockdowns from the start, as far-right President Jair Bolsonaro lashed out against isolation measures and urged people to go back to work. Mayors and governors initially clashed with Bolsonaro, shutting bars, malls, gyms, and beaches across the country. But Bolsonaro’s message resonated with many Brazilians hit by the financial blow of the pandemic. With local elections beginning on Nov. 15, many mayors have caved to political pressure to relax restrictions.
As other countries prepare to confront a second wave of the pandemic, Curado says Brazil has yet to emerge from its initial crisis. “We’re still in the first wave. It’s a wave with no end,” she said.
